| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,412 |
3,086 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
4,115 |
3,799 |
$85K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
818 |
364 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,307 |
3,064 |
$50K |
| D1110 |
Prophylaxis - adult |
986 |
930 |
$41K |
| D0272 |
Bitewings - two radiographic images |
1,820 |
1,741 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
484 |
222 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
908 |
745 |
$19K |
| D1999 |
|
1,198 |
785 |
$16K |
| D1206 |
Topical application of fluoride varnish |
590 |
572 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
489 |
424 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
511 |
424 |
$12K |
| D1351 |
Sealant - per tooth |
400 |
103 |
$10K |
| D0330 |
Panoramic radiographic image |
152 |
152 |
$8K |
| D0274 |
Bitewings - four radiographic images |
299 |
287 |
$8K |
| D2330 |
|
22 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
95 |
90 |
$993.30 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$237.60 |